Summary & Overview
CPT 99388: Comprehensive Preventive Medicine Reevaluation for Adults 18-39
CPT code 99388 represents a periodic comprehensive preventive medicine reevaluation and management service for established patients aged 18-39 years. This code is a cornerstone of preventive healthcare, supporting routine wellness visits that help identify risk factors and promote early intervention for adults in this age group. Nationally, preventive medicine services are recognized as essential for improving population health outcomes and reducing long-term healthcare costs.
Blue Cross Blue Shield is a key payer covering this service, reflecting broad commercial insurance support for preventive care. Readers will gain insight into the clinical context of 99388, including its role in routine office-based preventive medicine, typical patient demographics, and how it fits within the broader spectrum of preventive services. The publication also covers relevant policy updates, common billing practices, and benchmarks for utilization, helping stakeholders understand the importance of comprehensive preventive visits for young adults. Additionally, the summary provides an overview of related codes and modifiers, offering clarity on how 99388 is distinguished from other preventive medicine services. This information is valuable for healthcare administrators, policy analysts, and clinicians seeking to stay informed about preventive medicine billing and coverage trends.
CPT Code Overview
CPT code 99388 is used for a periodic comprehensive preventive medicine reevaluation and management service for established patients aged 18-39 years. This code is part of the preventive medicine service line and is typically performed in an office setting (Place of Service 11). The service includes a thorough assessment of the patient's health status, risk factors, and preventive care needs, aiming to promote wellness and early detection of potential health issues. This evaluation is designed for patients who are already established with the practice and is focused on maintaining health and preventing disease.
Clinical & Coding Specifications
Clinical Context
A 28-year-old established patient presents to the office (Place of Service 11) for a periodic comprehensive preventive medicine reevaluation and management visit. The patient has no acute complaints and is seeking routine health maintenance. During the visit, the provider reviews the patient's medical history, performs a general physical examination, updates immunizations, screens for risk factors such as diabetes, and discusses preventive health strategies. The provider documents the encounter and may address abnormal findings if discovered during the examination. This workflow aligns with the use of CPT code 99388 for preventive medicine services in patients aged 18-39 years.
Coding Specifications
-
Modifier
25: Used when a significant, separately identifiable evaluation and management service is performed by the same physician on the same day as another procedure or service. -
Modifier
33: Indicates that the service provided is a preventive service.
| Modifier Code | Description |
|---|---|
25 | Significant, Separately Identifiable Evaluation and Management Service by the Same Physician on the Same Day of the Procedure or Other Service |
33 | Preventive Services |
- Provider Taxonomies:
| Taxonomy Code | Specialty |
|---|---|
207Q00000X | Family Medicine Physician |
208000000X | Pediatrics Physician |
207R00000X | Internal Medicine Physician |
Related Diagnoses
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Z00.00: Encounter for general adult medical examination without abnormal findings- Used when the preventive visit reveals no abnormal findings.
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Z00.01: Encounter for general adult medical examination with abnormal findings- Used when the preventive visit identifies abnormal findings that require documentation.
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Z01.411: Encounter for gynecological examination (general) (routine) with abnormal findings- Used for routine gynecological exams in adult women when abnormal findings are present.
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Z01.419: Encounter for gynecological examination (general) (routine) without abnormal findings- Used for routine gynecological exams in adult women with no abnormal findings.
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Z13.1: Encounter for screening for diabetes mellitus- Used when diabetes screening is performed as part of the preventive medicine visit.
Each diagnosis code supports the clinical context of a comprehensive preventive medicine reevaluation and management visit for established patients aged 18-39 years.
Related CPT Codes
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99395: Periodic comprehensive preventive medicine reevaluation and management, established patient; 40-64 years- Used for established patients aged 40-64 years for similar preventive medicine visits. Alternative to
99388based on patient age.
- Used for established patients aged 40-64 years for similar preventive medicine visits. Alternative to
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99396: Periodic comprehensive preventive medicine reevaluation and management, established patient; 65 years and older- Used for established patients aged 65 years and older. Alternative to
99388for older adults.
- Used for established patients aged 65 years and older. Alternative to
-
99401: Preventive medicine counseling and/or risk factor reduction intervention(s) provided to an individual (separate procedure); approximately 15 minutes- Used for focused preventive counseling sessions. May be performed in addition to
99388if counseling is significant and separately documented.
- Used for focused preventive counseling sessions. May be performed in addition to
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99402: Preventive medicine counseling and/or risk factor reduction intervention(s) provided to an individual (separate procedure); approximately 30 minutes- Used for extended preventive counseling. Can be used alongside
99388when additional counseling is provided and documented.
- Used for extended preventive counseling. Can be used alongside
These codes are commonly used as alternatives based on patient age or as adjunct services for preventive counseling during the same visit.
National Reimbursement Benchmarks
For CPT code 99388, the national mean rate for Blue Cross Blue Shield and the average commercial benchmark (BUCA) is $80.02. Medicare rates are not available in the input, so a comparison between commercial and Medicare rates cannot be made.
Rate dispersion for both Blue Cross Blue Shield and BUCA is minimal, with the 25th, 50th, and 75th percentiles all at $80.00. This indicates a very tight range, with no variation across the percentiles for these payers.
The table and chart below present the full breakdown of national mean rates and percentile values for each payer.
Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.